Successful Bacteriophage Therapy for Treatment of Multidrug-Resistant Pseudomonas aeruginosa Infection in a Cystic Fibrosis Patient

Abstract

Introduction Bacteriophages are host-specific lytic viruses that are of increasing interest as adjunctive therapy for treatment of multi-drug resistant (MDR) pathogens. Case Report We describe the use of bacteriophage therapy (BT) in a 26-year-old cystic fibrosis (CF) patient awaiting lung transplantation who was admitted for respiratory failure requiring mechanical ventilation for 12 days. The hospital course was complicated by MDR Pseudomonas aeruginosa (PA) pneumonia, persistent respiratory failure, and colistin-induced renal failure (listed for concomitant kidney transplant). Due to worsening clinical status, BT was explored as an adjunct to antibiotics. The patient was approved under emergency IND#17710 by the FDA to receive AB-PA01 (combination of 4 lytic phages) active against the clinical PA isolates. This was given every 6 hours intravenously (IV) for 8 weeks. As noted in Figure 1, the patient was bed-bound due to severe dyspnea and required 30 L/min O2 via high flow nasal cannula (NC) at BT initiation. MDR PA pneumonia resolved by Day 7. Her respiratory status continued to improve and by end of therapy (EOT) she was on 4 L/min O2 via NC and was able to work with physical therapy. No adverse events related to BT occurred. There was no recurrent pneumonia or CF exacerbation within 90-days following the end of treatment. Renal failure resolved once off colistin and the patient was removed from the kidney transplant waitlist. Summary We describe the successful use of BT in a CF patient awaiting lung transplant. Given the concern for MDR PA in CF patients, BT may offer a viable anti-infective adjunct to traditional antibiotic therapy.